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Hands: Numbness and Carpal Tunnel Syndrome

I have numbness in my hands and fingers while sleeping. I've started spending more time bouldering in the gym and increasing the intensity level. I work at a desk (at Rock and Ice, by the way), and spend most of my day at the computer. Can climbing pinch the nerves in the wrist and lead to carpal tunnel? It feels like nerves are being pinched in my elbows, however, not the wrists. Can one have numbness in the hands because of pinched nerves in the elbows? Is muscle strength affected?

JASON GRUBBCarbondale, Colorado

The carpal tunnel is a bit like those mountain passages on the Swiss autobahn -- tight. Mostly things run smoothly, but when they don't, imagine a sewage truck being sucked into a gargantuan exhaust fan and you will get the idea.

The median nerve and nine tendons in the carpal tunnel are manacled by connective tissue on the front of your wrist (flexor retinaculum) and carpal bones on the back. If this passage cinches a little tightly, or tissues within become inflamed, the median nerve becomes compressed. The little finger is not usually involved, as the ulna nerve, which travels outside the carpal tunnel, supplies it.

The numbness combo you mention smacks of carpal tunnel syndrome (CTS), though it's not the only possibility. In theory, the median nerve can be compressed in several places between your neck and your wrist.

The numbness and pain pattern is normally sufficient for diagnosis, but any doubt can be cleared by a nerve conduction test (to evaluate signal strength along the nerve's pathway) that will demonstrate the site of compression. You can compress the median nerve around your upper forearm/elbow. It is, however, much less common and considerably more complex to diagnose without a nerve conduction study.

The first symptom of CTS is typically the numbness you describe. Weakness is certainly an issue, but is considerably more gradual and difficult to notice initially. Climb on, I say!

Stiffness in the carpal bones and/or tightness in the restraining tissues anteriorly are major causes of chronic nerve compression. Inflammation of structures within the wrist, such as tendons, may cause nerve compression, but this is typically more transient in nature. Pregnancy-induced edema is also possible. I know you are a man, but you can never be sure when taking a swim in today's gene pool. Better to be safe than surprised. Diabetes mellitus, hypothyroidism, acromegaly, amyloidosis and a few others that would sprain the tongue of a porn star are also possible culprits.

Surgery is usually successful. That said, surgery is usually unnecessary. The tendency of some surgeons to prematurely un-holster their scalpels is tantamount to bio-terrorism.

The solution is multi-pronged. Loosen the carpals, stretch the anterior retinaculum and regain normal motion. The rest will look after itself. Buying a brace will help stimulate the economy and little else.

An ergonomic mouse and keyboard may help alleviate some work-related stress. Tell Duane you need a holiday. I'll give you a sick note.